Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 36479 | TX |
Y | 103TC0700X | Clinical Psychologist | 36479 | TX |
NPI | 1003244187 |
---|---|
Provider Name | Dr. Wendy Bates |
First Address | Richardson, TX 75081-5579 |
Second Address | Richardson, TX 75081-5579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2013 |
Last Update Date | 02/10/2015 |